Allergy and asthma proceedings最新文献

Background: There is currently no accepted biomarker for predicting which patients will experience relapse after discontinuation of omalizumab therapy. Objective: This retrospective study aimed to identify clinical and laboratory markers associated with chronic spontaneous urticaria relapse. Methods: "Relapse" was defined as a urticaria control test score of <12 during the 6-month follow-up after treatment interruption after 24 weeks of therapy. Baseline demographic characteristics and laboratory values, including total immunoglobulin E (IgE), anti-thyroid peroxidase (TPO), C-reactive protein (CRP), and complete blood cell count parameters, were compared between patients who did and patients who did not experience relapse. Results: In the cohort of 43 patients, relapse occurred in 13 (30.2%). There were no significant differences between the patients who relapsed and those who did not relapse with respect to gender, age, disease duration, disease activity, concomitant angioedema, chronic inducible urticaria, atopic comorbidity, total IgE levels, or CRP levels. The median anti-TPO level was significantly higher in the relapsed group (p = 0.039), with an optimal predictive cutoff value of 67 IU/mL, with 62.5% sensitivity and 84.2% specificity (area under the curve 0.753; p = 0.041). Among the hematologic parameters, the mean platelet volume (MPV) was the only variable to differ significantly (p = 0.028), being lower in the relapsed group than in the non-relapsed group, and yielded an optimal cutoff value of 10.25 fL, with 92.3% sensitivity and 34.5% specificity (area under the curve 0.712; p = 0.03). Conclusion: In this retrospective, small-sample study, the anti-TPO level and MPV emerged as exploratory predictors of recurrence; however, their clinical utility requires validation in larger, prospective cohorts before implementation.

Background: One in five Americans turn to TikTok before calling their own physician. Objective: With social media on the rise as a source of health-related information, we aimed to investigate and evaluate popular content about mast cell activation syndrome (MCAS) on TikTok. Methods: Between June 14 and 16, 2024, four different MCAS-relevant phrases were searched on TikTok, and the top 50 most watched videos were analyzed independently by three subinvestigators. The global quality score (GQS) (range from 1 to 5) was applied to assess the value of the educational videos. The profession of the content creator, use of MCAS Vienna diagnostic criteria, association with postural orthostatic syndrome (POTS)/Ehlers Danlos syndrome (EDS), and information trends were also analyzed. Results: The 50 most watched MCAS-related videos collectively had > 6.5 million views, and the average number of views per video was 131,500. Most videos were created by health-care professionals (58%), including physicians (26%) and other health-care professionals (32%), whereas the minority were created by non-health-care professionals (42%). Only one video included the MCAS Vienna criteria (2%), and 12 videos associated MCAS with POTS and/or EDS (24%). The average GQS was 1.94 (SD 0.34). Common MCAS misinformation trends included the following: inaccuracy of symptoms, diagnostic criteria, triggers, and treatment options. Conclusion: Most MCAS videos on TikTok contained misinformation, did not include key diagnostic criteria, and had poor GQS. The most viewed videos were primarily created by health-care professionals. Patients and health-care providers need to be aware of the quality of health-care information on social media.

Background: An Hymenoptera venom allergy diagnosis requires sting-triggered systemic reaction symptoms and evidence of venom-specific immunoglobulin E (IgE) through skin or serologic testing. A lack of concordance between skin and serologic testing has been reported previously; using these tests in a complementary fashion has been emphasized in published guidelines. Objective: We assessed skin and serologic venom-specific IgE testing discordance and factors that impact the testing. Methods: A retrospective review of patients with allergist-diagnosed winged Hymenoptera venom allergy prescribed venom immunotherapy at one center from 2005 to 2023 was completed. Record review included demographics, Mueller grading reaction severity, and venom testing results. Patients were included if they had both skin and serologic testing results. Results: A total of 125 records were reviewed, with 33 meeting inclusion criteria. Patients were 7-69 years old, 55% female, and Mueller grade 2 and above reactions occurred in 94%. Kappa coefficients for both tests for individual winged Hymenoptera were all <0.35. Discordance occurred 37% of the time overall; no venom was found to be more or less discordant than the others. Skin testing results were found to be positive more frequently than were serologic testing results overall (p = 0.0126), in male individuals (p = 0.007), when the initial sting was at >18 years old (p = 0.016), when testing was completed at >30 years old (p = 0.006), and when there were >5 years between the initial sting and testing (p = 0.007). Conclusion: Skin and serologic testing for winged Hymenoptera are frequently discordant, and both should be tested to confirm or refute negative results. In certain populations, skin testing should be completed first.

Background: Systemic corticosteroids (SCS) are widely used to treat patients with chronic rhinosinusitis with nasal polyps (CRSwNP) that is insufficiently controlled with first-line treatments. However, such treatment must be balanced against the risk of adverse effects with protracted or repeated use. Increasing awareness of these adverse effects and the introduction of biologics are changing established management approaches. Objective: The objective was to review the role of SCS in the management of CRSwNP in the evolving treatment landscape. Methods: A literature search was conducted for salient articles on SCS in CRSwNP, including guidelines. Results: SCS reduce inflammation through broad actions on various immune mediators. Short courses of SCS improve symptoms (especially olfactory function) and reduce polyp size, benefits that do not persist long-term after treatment ends. SCS are widely used before endoscopic sinus surgery to improve the visibility of the surgical field and after surgery to improve outcomes, although evidence for benefit of postsurgical SCS is lacking. Adverse effects associated with SCS can manifest in a wide range of organs and systems. Use of SCS in patients with CRSwNP is associated with an increased risk of avascular necrosis, pneumonia, obesity, anxiety and/or depression, fracture, sleep apnea, hypothalamic-pituitary-adrenal axis suppression, diabetes, and hypertension. The SCS dosage regimen for CRSwNP is not well defined, and there is wide variation in clinical practice. Clinical guidelines refer to "short courses" of SCS but provide minimal guidance and lack consensus. Biologic treatments for CRSwNP have well-documented steroid-sparing effects, but the extent to which biologics might be able to reduce the use of or replace SCS may depend on economics as well as relative benefit-to-risk ratios. Conclusion: Short courses of SCS are widely used in patients with CRSwNP, but their use must be balanced against the risk of adverse effects. Use of biologics may reduce the use of SCS in CRSwNP, minimizing these adverse effects.

Background: Data on the frequency of food sensitivity (FS) and food allergy (FA) in patients with atopic dermatitis (AD) differ among studies. Objectives: The aim of this study was to determine the frequency of FS and FA in different AD phenotypes according to the age of onset and severity of AD. In addition, we aimed to investigate the risk of FA in these patients. Methods: Patients diagnosed with AD between 2022 and 2024 were included in the study. All patients with AD admitted during this period were analyzed for the coexistence of FA and FS. Results: The study included 257 children with AD. Of these patients, 147 of 257 were girls (57.2%). The median (interquartile range [IQR]) age of onset of AD was 6 months (2.5-30 months). By the age of AD onset, FS and FA were present in 60.3% and 32.5%, respectively, in patients with moderate-to-severe AD, with disease onset between ages 0 and 3 months. Among the patients with disease onset between ages 4 and 11 months, the corresponding rates in moderate-to-severe cases were 59.6% for FS and 17.4% for FA. FS was present in 39.3% of moderate-to-severe cases with AD onset age after 12 months, but none had FA. Being in the moderate-to-severe category for AD increased the risk of FA 14-16 times compared with the mild AD group. Conclusion: FS is significantly more prevalent than FA in patients with AD. In children in whom FS test results are positive, the diagnosis of AD-FA coexistence should not be made without performing an elimination diet and oral food challenge test. This approach will help prevent unnecessary food elimination.

Background: Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic rhinitis (AR), allergic asthma, and, potentially, atopic dermatitis (AD) in children. Despite demonstrated efficacy, AIT remains underutilized in the United States. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) both reduce symptoms and medication use, although much supporting evidence comes from non-U.S. studies by using extracts not approved domestically. Moreover, most U.S. trials of multiallergen SCIT lack rigorous placebo controlled data. Objective: The objectives were to examine current evidence on pediatric AIT, evaluate clinical efficacy and safety, and highlight key research gaps, particularly within the U.S. context. Methods: A literature search was conducted by using terms that included pediatric AIT, SCIT, SLIT tablets; SLIT drops; and off-label SLIT. The review focused on AIT for AR, asthma, and AD in children, with comparative analysis of SCIT and SLIT in terms of efficacy, safety, and preventative potential. Results: Both SCIT and SLIT are effective for AR and, to a lesser extent, asthma and AD. SLIT tablets offer the advantages of at-home use and a favorable safety profile but in the U.S. are limited to single allergens, which poses challenges for patients who were polysensitized. AIT shows potential for tertiary prevention, such as delaying asthma onset or reducing new sensitizations, although more U.S.-based pediatric data are needed. SCIT carries a risk of systemic reactions; SLIT maintains excellent safety. Knowledge gaps remain with regard to optimal treatment duration, extract formulation, and multiallergen use in children who are polyallergic. Conclusion: AIT is a valuable disease-modifying option for pediatric allergic diseases, but broader U.S. adoption is hindered by regulatory, reimbursement, and evidence limitations. Shared decision-making is critical to align treatment with patient needs. High-quality U.S.-based studies are essential to optimize care and long-term outcomes for children who are allergic.

Background: Allergen immunotherapy (IT) in Europe is generally administered as monoallergen IT. However, in some patients and in other parts of the world, multiallergen IT is common practice. A key question is whether allergens in a mixture retain their allergenicity over time. Objective: To demonstrate if allergenicity, as measured by skin-prick testing (SPT), is maintained after 6 months in a sublingual immunotherapy (SLIT) maintenance vial with three allergen extracts in a single individual vaccine, including two pollens and Dermatophagoides. Methods: We prepared two maintenance SLIT vials that contained mixed Dermatophagoides species (2000 AU/mL), ash tree and Bermuda grass pollens (1:50 w/v), one 6 months before SPT and the second 0-2 weeks before SPT, and three fresh vials (0-2 weeks before SPT) for each individual allergen. Duplicate SPTs were conducted with all five vials, diluent and positive (histamine 1 mg/mL) controls. Wheals were measured at 10 minutes (controls) and 20 minutes (allergen vaccines). The mean wheal diameter was calculated as the average of the longest and orthogonal diameters, i.e., (D₁ + D₂)/2. For each allergen extract, two replicate wheals were obtained per participant; their mean diameters were averaged to yield a patient-level mean wheal diameter. These patient-level means were then averaged across all the participants. The paired t-test was used to calculate statistically significant differences between the mean wheal diameters of the extracts, with significance at p < 0.05. Results: The mean ± standard deviation wheal diameter produced by the 6-month-old and the fresh extracts were 8.7 ± 3.3 mm and 8.4 ± 2.87 mm, respectively. This difference was not significant. Moreover, the potency of both pollen extracts was conserved when mixed with house-dust mite extracts. Conclusion: In our pilot study, allergenicity of tree and grass pollen allergens in an allergen mix with Dermatophagoides in a SLIT maintenance vial was maintained over 6 months. Replication in a larger population would consolidate our findings.

Background: Beta-lactam allergy (BLA) labels are common in children but often disproven when formally evaluated. This diagnostic discrepancy leads to higher health-care costs and increased adverse outcomes. Beta-lactam antibiotics are associated with a variety of adverse reactions in children. A serum sickness-like reaction (SSLR) is one adverse reaction that is complex in its diagnosis and management due to its heterogeneous clinical presentation and poorly understood mechanism. This unclear presentation and diagnostic criteria can be confusing for patients, families, and health-care professionals, leading to allergy evaluation hesitancy. With updated drug practice parameters that support the utility of oral drug challenges for patients with SSLRs related to beta-lactams, barriers remain for these patients to seek allergy evaluation. Objectives: The objective was to assess caregiver perspectives on BLA delabeling and identify barriers to drug challenge testing in children with a history of SSLRs. Methods: We conducted an 18-question telephone survey with 14 caregivers of children with a history of beta-lactam-associated SSLR. The survey assessed attitudes toward allergy delabeling, understanding of challenge testing, and perceived barriers to testing. Results: Most caregivers demonstrated an understanding of the importance of allergy delabeling; however, the comfort level with challenge testing varied, depending on the setting, provider, and perceived risk of SSLR recurrence. Of the caregivers, 62.4% reported feeling comfortable with their child's pediatrician performing the testing. When asked about their concerns about testing, nearly 50% of caregivers expressed concern about the possibility of a repeated SSLR. Conclusion: The overall positive attitude toward BLA testing, especially in a primary care setting, highlights an opportunity to make testing more accessible for patients. However, the unpredictable nature of SSLRs seems to contribute to caregiver reservations about pursuing testing for their child. To mitigate this, targeted education from health-care professionals, such as physicians, advanced practice providers, and nurses, may reduce caregiver hesitancy and facilitate BLA delabeling for patients with SSLRs.